- Design
- Retrospective multicentre case-control study with literature review
- Population
- 29 alopecia areata patients with texture change and 145 controls
- Primary outcome
- Clinical and ultrastructural features of post-regrowth hair texture change
- Effect
- Acquired pili torti on electron microscopy; 17.2% (5 of 29) reverted to straight hair at median 7 months
A retrospective multicentre case-control study compared 29 patients with alopecia areata who developed a change in hair texture on regrowth with 145 controls, and added a literature review with five further cases.
Texture change was more frequent in females and in severe-to-very-severe diffuse disease or alopecia totalis or universalis. It usually appeared 4 to 12 weeks after JAK inhibitor or systemic steroid treatment, or after spontaneous regrowth. Scanning electron microscopy showed acquired pili torti. Five of 29 (17.2%) went back to straight hair after a median of 7 months, while the rest stayed curly at a median 12 months.
The authors judge it more likely a feature of the recovering follicle than a treatment effect, though a retrospective design cannot separate the two. It is worth telling patients before treatment so that curly regrowth is not mistaken for a reaction or relapse.
- Mention possible texture change when counselling about regrowth in severe alopecia areata.
- Look for flattened, twisted shafts with trichoscopy in new curly regrowth.
- It followed JAK inhibitors, steroids and spontaneous regrowth, so do not stop treatment on this alone.
- About one in six patients regained straight hair within a year in this series.
Why it matters
A change in texture can be mistaken for a drug reaction or a new disease unless clinicians expect it.
Don't overread it
Retrospective and small; it does not show that treatment is not involved.
The statistics, in plain English
With only 29 cases, the associations with sex and severity are descriptive. A case-control design identifies who has the feature but cannot show what caused it.
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